Meeting international standards: A cultural approach in implementing the mini-CEX effectively in Indonesian clerkships

Background: Medical schools all over the world try to adapt their programs to meet international standards. However, local culture might hamper innovation attempts.

Aims: To describe challenges in implementing the mini-CEX in Indonesia and investigate its effect on students' clinical competence.

Methods: The study was conducted in the Internal Medicine and Neurology departments of the Universitas Gadjah Mada, Indonesia. Implementing the mini-CEX into the existing curriculum, while taking the Indonesian culture into account, implied a shift from group to individual feedback. We compared students' final clinical competence before (Internal Medicine n = 122, Neurology n = 183) and after (n = 183 and 186, respectively) the implementation of the mini-CEX, using a modified Objective Structured Long Examination Record (OSLER). The Mann-Whitney test was used to analyze the data.

Results: We took power distance and individualism into account to facilitate the implementation process. After implementing the mini-CEX, the OSLER results were significant higher in Internal Medicine (p

Conclusion: By managing the innovation process carefully and taking culture and local context into account, the mini-CEX can be implemented without changing the underlying concept. The shift from group to individual feedback seems to have a positive effect on student learning.